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Psych > 30. Addiction and Substance Abuse > Flashcards

30. Addiction and Substance Abuse Flashcards

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1
Q

what must nurses be aware of when caring for a pt w/ substance abuse

A
  • self awareness

- countertransference

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2
Q

continued use despite adverse consequences

A

addiction

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3
Q

ingestion, smoking, sniffing, or injecting of mind-altering substances

A

use

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4
Q

one or more drugs needed to function

A

dependence

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5
Q

use for purposes of intoxication, beyond intended use, can lead to dependence

A

abuse

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6
Q

sxs occurring when substance no longer used

A

withdrawal

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7
Q

process for safe withdrawal

A

detoxification

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8
Q

recurrence

A

relapse

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9
Q

what type of substance is alcohol

A

CNS depressant

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10
Q

immediate effects of alcohol

A
  • disinhibition
  • euphoria
  • sedating
  • CNS depressant
  • potentially fatal in excess
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11
Q

long term effects of using alcohol

A
  • harmful changes in liver, GI, bone density, muscles, and immune system
  • permanent brain damage
  • dementia (Wernicke’s encephalopathy and Korsakoff’s syndrome)
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12
Q

alcohol effect caused by a thiamine deficiency; causes vision impairment, ataxia, hypotension, and confusion

A

Wernicke’s encephalopathy

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13
Q

alcohol effect that causes heart, vascular, nervous system involvement; difficulty acquiring new info and retrieving memories -> causes them to make up new memories (confabulation)

A

Korsakoff’s syndrome

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14
Q

difference between Wernicke’s encephalopathy and Korsakoff’s syndrome

A
  • Wernicke’s: comes on suddenly and needs to be treated immediately (thiamine replacement)
  • Korsakoff’s: long-term ongoing problem
  • Wernicke’s can lead to Korsakoff’s
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15
Q

effects of alcohol on the body

A
  • peripheral neuropathy
  • alcoholic neuropathy
  • alcoholic cardiomyopathy (weakness heart muscle)
  • esophagitis
  • gastritis
  • pancreatitis
  • alcoholic hepatitis and cirrhosis
  • leukopenia
  • thrombocytopenia
  • sexual dysfunction
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16
Q

use of alcohol during pregnancy leads to problems w/ learning, memory, attention span, communication, vision, and hearing

A

fetal alcohol syndrome (FAS)

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17
Q

manifestations of fetal alcohol syndrome (FAS)

A
  • small for gestational size
  • facial abnormalities
  • poor coordination
  • hyperactive behavior
  • learning disabilities
  • low IQ
  • problems w/ daily living
  • vision/hearing problems
  • poor judgement and reasoning
  • heart and kidney defects
  • abnormal size and shape of brain
  • risk for psych disorders
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18
Q

theories for alcohol dependence

A
  • genetics
  • biochemical: may produce morphine-like substances in the brain -> causes addition
  • developmental factors
  • certain personality traits play part in both development and maintenance of alcohol dependence
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19
Q

phase of alcohol abuse where it is used to relieve everyday stress and tensions of life

A

phase I: pre-alcoholic phase

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20
Q

phase of alcohol abuse where there are brief periods of amnesia that occur during or immediately following drinking; alcohol is now required

A

phase II: early alcoholic phase (blackouts)

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21
Q

phase of alcohol abuse where control is lost and there is physiological dependence

A

phase III: crucial phase

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22
Q

phase of alcohol abuse where there is emotional and physical disintegration; intoxicated more often than sober

A

phase IV: chronic phase

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23
Q

assessment tools for alcohol use

A
  • Michigan alcoholism screening test (MAST)
  • AUDIT questionnaire
  • CAGE questionnaire (CUT, Annoyed, Guilty, Eye Opener)
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24
Q

usually occurs within 12 hours after abrupt discontinuation of alcohol; may include delirium tremens

A

alcohol withdrawal syndrome

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25
Q

scale used to determine management for alcohol withdrawal

A

clinical institute withdrawal assessment of alcohol scale (CIWA scale)

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26
Q

pharmacology used to ease the alcohol withdrawal period

A
  • benzos (Librium, Ativan, Diazepam)
  • antidepressants
  • sleep meds
  • antipsychotics
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27
Q

how to determine which benzos to give for alcohol withdrawal

A
  • Librium and Diazepam have longer half life and are smoother to taper off
  • Ativan given if pt has liver impairment
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28
Q

stage I of alcohol withdrawal syndrome

A
  • increased HR and temp
  • normal or slightly elevated BP
  • slight diaphoresis
  • oriented w/ no confusion or hallucinations
  • mild anxiety and restlessness
  • hand tremors w/ no seizures
  • impaired appetite and nausea
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29
Q

stage II of alcohol withdrawal syndrome

A
  • HR 100-120
  • systolic BP and temp elevated
  • obvious diaphoresis
  • intermittent confusion and transient hallucinations
  • painful anxiety and restlessness
  • insomnia and nightmares
  • visible tremors and rare seizures
  • anorexia, N/V
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30
Q

stage III of alcohol withdrawal syndrome

A
  • HR 120-140
  • BP and temp elevated
  • marked diaphoresis
  • marked disorientation, confusion, disturbing visual and auditory hallucinations, and delusions
  • delirium tremens
  • extreme restlessness and panic states
  • unable to sleep
  • gross uncontrollable tremors and seizures common
  • reject all fluid and food
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31
Q

complications of alcohol withdrawal

A
  • withdrawal seizures
  • alcoholic hallucinosis (12-24 hours after last drink; resolve in 24-48 hours
  • delirium tremens (DTs) - most severe form of alcohol withdrawal
32
Q

describe withdrawal seizures

A

generalized tonic-clonic confusions usually 12-48 hours after last drink

  • may occur within 2 hours
  • 30-40% w/ seizures progress to delirium tremens
33
Q

manifestations of delirium tremens (DTs)

A

occurs 3-10 days following last drink

  • agitation
  • global confusion
  • disorientation
  • hallucinations
  • fever
  • HTN
  • tachycardia
34
Q

most common conditions leading to death in pts w/ DTs

A

respiratory failure and cardiac arrhythmias

35
Q

treatment of DTs

A
  • adequate nutrition
  • medication
  • multivitamin therapy
  • thamine
36
Q

3 medications used for DTs

A
  • Disulfiram (Antabuse)
  • Naltrexone
  • Acamprosate
37
Q

MOA of Disulfiram

A
  • inhibits aldehyde dehydrogenase (ETOH oxidation)
  • build up of acetaldehyde
  • causes sickness if taken w/ alcohol
38
Q

MOA of Natrexone

A

binds to opioid receptor and inhibits action of opioid drugs -> may prevent high feeling from using alcohol and decrease cravings

39
Q

MOA of Acamprosate

A

reduces cravings by rebalancing glutamate and GABA NTs

40
Q

how to prevent alcohol relapse

A
  • psychosocial interventions
  • cognitive behavioral interventions (examine thinking process that leads to alcohol use)
  • motivational approaches (motivational interview -> very effective)
41
Q

describe alcoholic anonymous (AA)

A
  • major self-help organization that gives peer support, acceptance, and understanding from those who have experienced same problem
  • 12 steps provide specific guidelines on how to obtain and maintain sobriety
42
Q

T/F: total abstinence is the only cure for alcoholism; pt can never socially drink again

A

True

43
Q

describe harm reduction programs

A
  • ran by professionals to reduce consumption and work towards abstinence
  • not required to turn over recovery to a higher power
44
Q

describe sedatives, hypnotics, and anxiolytics

A
  • sedatives: have calming effects on CNS
  • hypnotics: induce sleep
  • anxiolytics: anti-anxiety meds
45
Q

found in coffee, tea, chocolate, energy drinks, diet pills, and headache remedies

A

caffeine

46
Q

effects of caffeine

A
  • increase person’s perceived level of energy alertness

- increase BP and may lead to increase production of cortisol

47
Q

psychoactive substance found in cigarettes

A

nicotine

48
Q

effects of nicotine

A
  • stimulates release of adrenaline (NE)

- increases BP, HR, and RR

49
Q

signs of nicotine withdrawal

A
  • anxiety
  • irritability
  • depression
  • difficulty concentrating
  • sleep disturbances
  • headaches
  • increased appetite
50
Q

2 medications used to help people quit smoking

A
  • Zyban

- Chantix

51
Q

types of inhalants

A
  • volatile solvents
  • aerosols
  • gases
  • nitrates
52
Q

effects of inhalants

A
  • euphoria
  • sedation
  • emotional lability
  • impaired judgement
  • chronic neurologic syndrome possible for long-term use
53
Q

intoxication of inhalants

A
  • respiratory depression
  • stupor
  • coma
  • risk for “sudden sniffing death” -> suffocation or cardiac arrhythmias
54
Q

what type of substance is cocaine

A

CNS stimulant

  • increases dopamine (euphoria and psychotic sxs)
  • increases NE (tachycardia, HTN, dilated pupils, and elevated temp)
  • increased serotonin (sleep disturbances and anorexia)
55
Q

effect of cocaine

A

sudden burst of mental alertness and energy; feelings of self-confidence and being in control

56
Q

how long does the cocaine rush lasts

A

about 10-20 minutes followed by intense let-down effect that causes irritability, depression, tiredness, and craving more drug

57
Q

effects of amphetamines

A
  • CNS stimulant

- blocks reuptake of NE and dopamine w/ lesser effect on serotonin; also has peripheral nervous system effects

58
Q

list of CNS stimulants

A
  • cocaine
  • amphetamines (includes ADHD meds)
  • methamphetamine
  • MDMA (Ecstasy)
  • Rohypnol GHB, Ketamine
59
Q

effects of methamphetamine

A
  • CNS stimulant
  • release of excess dopamine
  • highly additive
  • used in a binge and crash pattern
60
Q

effects of MDMA (Ecstasy)

A
  • increase serotonin and excess dopamine release
  • causes hallucinations, confusion, depression, sleep problems, drug craving, severe anxiety, and paranoia
  • possible malignant hyperthermia
61
Q

what drug is also know as the date rape drug

A

Ketamine (odorless, tasteless, and colorless)

- when mixed w/ alcohol -> incapacitated w/ sedated euphoric effect and produces anterograde amnesia

62
Q

effects of cannabis on body

A
  • CV effects
  • respiratory effects
  • reproductive effects
  • CNS effects
  • sexual functioning
63
Q

what is Marinol

A

FDA approved drug w/ THC in it that is given to chemo patients to stimulate appetite

64
Q

effects of hallucinogens

A
  • euphoria or dysphoria
  • altered body image
  • distorted or sharpened visual and auditory perception
  • confusion and incoordination
  • impaired judgement and memory
65
Q

severe reactions to hallucinogens

A
  • paranoia
  • fear of losing one’s mind
  • depersonalization
  • illusions
  • delusions
  • hallucinations
66
Q

type of hallucinogens

A

more than 100 different types

  • psilocybin (mushroom)
  • D-lysergic acid diethyl amide (LSD)
  • mescaline
  • numerous amphetamine derivatives
67
Q

types of opioids

A
  • oxycodone
  • hydrocodone
  • morphine
  • fentanyl
  • codeine
  • heroin (type of opioid)
68
Q

side effects of opiods

A
  • constipation
  • dulled senses
  • slowed HR and RR
  • euphoria/confusion
  • dependency/addiction
  • urinary retention
69
Q

effects of repeated activation of opioid receptor

A
  • euphoria
  • physical dependence
  • analgesia
  • depression
  • respiratory depression (common cause of death)
  • sedation
70
Q

signs of opioid overdose

A
  • extreme sleepiness
  • slow shallow breathing
  • fingernails or lips turn blue-purple
  • small pinpoint pupils
  • slow HR and BP
71
Q

what is used to treat opioid addiction

A
  • Methadone - given over 21 days and tapered down; reduces craving and withdrawal sxs
  • Naltrexone/Vivitrol (injectable form) - used for opioids and alcohol addiction
72
Q

pt education after treatment for opioid addiction

A
  • after tx -> tolerance is reduced

- if they resume using after tx -> not be able to use same amount as before -> could be lethal

73
Q

management of substance use disorder

A
  • activities to substitute substances int times of stress
  • relaxation techniques
  • problem solving skills
  • harm reduction strategies
  • 12 step programs
74
Q

signs of chemical dependency in nurses

A
  • mood swings and inappropriate behavior at work
  • noncompliance w/ acceptable policies and procedures
  • deteriorating appearance and job performance
  • sloppy illegible charting
  • alcohol on breath
  • forgetfulness and poor judgement
  • lying
  • high achievement
  • volunteering for OT or extra duties
  • onset after prescription after sx or chronic illness
  • FHx of alcoholism or addiction
75
Q

describe gambling addiction

A
  • non-substance related disorder
  • preoccupied w/ gambling and experience aroused euphoric state during actual betting
  • highly competitive, energetic, restless, and easily bored
  • more likely to commit suicide and less likely to seek mental health tx
  • staff education and family involvement are important

Psych (17 decks)

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